critical care

I was 14 when I nearly considered deliberate defenestration. It’s probably the closest I’ve ever been to suicide, but the memory of the angst that made me contemplate this action is still vivid.

The Headmaster had asked each of the 30 pupils in our class to give a talk. I cannot even remember the details now, but the prospect of standing in front of my peers caused me so much distress that jumping out of a fourth floor window seemed easier. Kind compassionate man that he was, he recognised my distress and engineered the situation such that I did not have to speak…hence I am still here.

Since then I have struggled with confidence … particularly confidence in public speaking. I have worked to overcome this, such that now I quite enjoy giving a talk on something which I am passionate about (trauma, airway, rural medicine). But talking on the big stage at smaccGOLD was a huge hurdle for me.

“Innovation, education and creativity at the cutting edge and beyond the confines of convention. This conference was delivered by passionate patient focused, idea-nurturing visionaries”

As Mike Cadogan said, if FOAMed was conceived (like many great ideas) in a Dublin bar at ICEM2012, then smacc2013 in Sydney marked FOAMed’s birth. I spoke at smacc2013 on my passion of rural prehospital care & was invited back to smaccGOLD. Thanks to the convenors, I was privileged to be invited to help teach in the pre-conference Airway Workshop, to enter into a debate with Minh le Cong and to deliver another presentation on rural resus room management.

Like all of the other presenters, I poured my heart and soul into preparation, yet with the spectre of my fears on public-speaking still present.

Preparation for speaking at smaccGOLD was one thing; being nominated to participate in #SimWars was another…all the stress of being on a stage, with the challenge of overcoming fear of public humiliation due to failure. I was pushed far out of my comfort zone – and this was a good thing.

Many people have asked me what makes smacc special. From fears such as those of Scott Weingart at smacc2013 that it was going to be “just five guys in a bar talking about Twitter”, smacc has evolved into THE leading critical care conference and is a wonderful demonstration of the power of FOAMed & Social Media.

Those who engage in FOAMed share a passion for advancing their craft, for sharing ideas and for education – in short, they strive to make themselves and the care of their patients “better”.

At the same time, it is not uncommon for people to experience fears – fear of sharing thoughts and work in a free, open-access format; fear of criticism of our expertise by those operating in another arena, fear of difficulty. My passion for FOAMed was predominantly driven by fear. Fear that as an isolated rural clinician I would be at risk of being the weakest link in management of my patients and friends.

My obsession about difficult airway management and critical care was borne from a ‘lesson hard learned’ – and a commitment to overcome both my own fear and ensure that harm does not befall any patient through lack of training, equipment or expertise. FOAMed resources, harnessed through the power of social media, enable us to engage in asynchronous learning from experts worldwide – and there is no longer any reason nor excuse not to be aware of the latest medical developments relevant to my practice.

“Fear is what drives much behaviour.

But I think we are best when driven by love”

The most important lesson that I’ve learned in medicine is to love your patients (no, not in that way!). A colleague taught me the power of a handshake when I was an ED registrar – not just as a formal introduction to each patient, but also to emphasise the symbolic nature that I am genuinely here to help you.The handshake is an affectation that I have carried on into my work in primary care…and along the way I’ve added other tools – sitting at patient level, giving the patient time, not being afraid to have the difficult conversations, showing empathy and ensuring we use names, not bed numbers.

This isn’t just about the doctor-patient relationship; it is also about how we interact and look after each other – we operate in different systems, and it is too easy to criticise colleagues or different craft groups without understanding their circumstances or challenges. And love is what mades smaccGOLD such a good conference. Sure there were inspiring speakers, great slide sets and some excellent hardcore critical care research. But there was also love – a shared passion for critical illness, a willingness to laugh and cry and play together, sessions on end-of-life care and bariatric medicine that challenged us to really think about our values as clinicians.

smaccGOLD was set modelled around a tribal theme – a main stage set that mimicked a tropical island (akin to an episode of ‘Lost’ or ‘Survivor’). Delegates and speakers strove to break down the traditional silos between us, to consider aspects of critical care from different perspectives – and to unite in common love for critical care and celebration of the joy of discovery.

smaccGOLD – breaking down the silos in critical care – we are but one tribe!

Ultimately we are all human – and the power of empathy, compassion and shared humanity is what binds us. Was it practice-changing? Yes! The rapid dissemination of ideas via FOAMed and the global community of enthusiasts dedicated to bringing “quality care, out there” is achieving its goal.

“smaccGOLD – grilled my corn!”

I simply cannot think of another critical care, emergency medicine or indeed any medical conference that came even remotely close.

Thank you to all – the organisers, those who helped me overcome my fears, those who shared their love of critical care & humanity – and everyone who made time to come up and say “G’day”.

You’re gonna do WHAT with that Cric-Key? Weingart plays fast n looseWho’s gonna be the mummy & who is the daddy? Karel Habig & Anthony Lewis arrive in same costume for #SimWars“Might as well shove it up your arse” from John Hinds in Cricoid debateThe laryngeal handshake – LeCong vs ChrimesRural Resus Room MxCarley goes wild“Punk Rock, Top Gun & Emergency Medicine” – from Deniz Tek of Radio Birdman

Tim Leeuwenburg

RESUSCITATE - DIFFERENTIATE - INVESTIGATE

I am a Rural Doctor on Kangaroo Island, South Australia with interests in emergency medicine, anaesthetics & trauma. When not working I enjoy fiddling with chainsaws and seakayaking. Along with partner Patricia we rehabilitate orphaned wildlife and devise roadkill recipes.